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15074APPLICANT TO FILL IN INFORMATION WITHIN RED LINES - USE BALL POINT PEN ONLY . . BU I LDING PROJECT IDENTIFICATIONPERMIT APPLICATION & PERMIT BUILDING - ELECTRICAL- PLUMBING - MECHANICAL NUMBER .. 150-74 BUILDING AceREss �, , ` Mke 5L OWNER'S PLAN CHIC IDATION NA e HONE i QTY. ELECTRIC PERMIT FEE / 93 CONTRACTORS NAME / UTLETS-SWITCHES-RECEP 10.00/1.00 LIGHTING FIXTURES 10.00/1.00 qQ "C. rvo. C+JVr46 DATE OF APPLICATION CONTRACT� ADDR 55 ' vHOrvE �/• ��/ PPLIANCES- RESIDENTIAL 4.00 PANELS 10,00 ARCHITECT on CNGINEeR LIC . No. PANELS (OVER 200 AMP) 2000 PLAN CHECK FEE P..C. NO. SIGNS TRANS. 3.00 ARCH. eo iss ENO' SPECIAL CIRCUIT S.00 PERMIT VALIDATION TEMP. METER OR POLE INS. 20.00 ZIP .:., APPLICANT'S ADDRESS MOTORS SEE FEE SCH. SERVICECHANGE 20.00 LICENSED CONTRACTORS DECLARATION �LCZ�r-� (/ 0, I hereby affirm that 1 am licensed under Powisimt of Chapter 9 ISSUANCE DATE (emnmencing will, Section 7000) of Division 3 of the Business and Professions Co and m license is in full force and Q• t . / License Class_ Lic. Number DJte_�. �F ComraClor�/ry/;/�y��n�� L BLDG. ELECT. PLG. MECH. w,O rN BUILDING PERMIT OWNER41UIL DC R DECI- AiYfi IONS I hereby collthat 1 any exempt 031.5 the Contractor's License Lawforthe followingreason.(Sec 70resa PerBusmittoCndtrct,S Stec, Code: Any city or county which requirese permit toconsua ce, also improve, Demolish, or repair any structure. prior to its issuance, also INFORMATION VALUATION 5/FT. �. MISC.- REFER TO ORD PERMIT ISSUANCE ELEC. CONTE. LIC. NO. ELEC. requires the applicant for such permit to file a signed statement that he is licensed pursuant to the provisions of the Contractor's License(� TOTAL PERMIT TO Law (Chapter 9(commencing with Section 7000)of Division 3 of the Business and Professions Code) or that he is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects the applicant to a civil penally of not inure than five hundred dollars ($500).): . PLUMBING PERMIT 03 QTY FEE JKJ //L//t-(/,('Cr CUL. STORIES TYPE CONSTR. ALTER -DRAIN & VENT -WATER (EA.) 5.0067�0-_6164//7d ❑ I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business and Professions BACK F LOW PROTECT. DEV ICE 4.00 -C/v OCC. GROUP RES. UNITS DRAINS -FLOOR, ROOF, AR EA, COND. 5.00 Code: The Contractor's License Law does not apply to an owner of property who builds or improves thereon, and who docs such work FIXTURES - PER TRAP 5.00 SC. FT. FLOOR AREA TOTAL ACREAGE hint elf or Ihmugh his own employee...... sided that such if .... rove mems are not intended or offered for sale. ll', however, the building GAS-EA.SYSTEM-11NC.40UTLETS 6.00 or improvement is sold within one year of completion, the owner- builder will have the burden of proving that he did not build or im prove for purpose of sale.). 0 1, as owner of the properly, full exclusively contracting with GAS - EA. SYSTEM -OVER 4 (EA.) 2.00 BUILDING USE RES IND CON PB Omer ❑ [3 [3❑ ❑ INDUSTRIAL WASTE INTER. 30.00 LAWN SPRINKLERS- 1 INC 5 V.B. 6.00 LAWN SPRINKLERS - OVER 5 (EA.) 1.00 ASSESSORS PARCEL NO. licenwd contractors to construct the project (See 7044. Business and Nofessimt Code.: The Contractor's License Law docs not apply to an owner of property who builds or improves thereon. and who contracts for such projects with a contructar(s) licensed pursuant In the C'ontractor's License Law. SEWER -SANITARY -STORM EA. 200ft/10.00 TRACT NO. PARCEL NO. WATER HEATER W/VENT 6.00 ❑ lam exempt under Sec--- B.&P.C. for this reason Owner Date WATER SYSTEM 5.00 ACG DATE ACC. FILE NO. WATER TREATING EQUIP. 5.00 WORK ERS'CONIPENSA'rION DECLARATION 1 hereby atfi in that I have a certilieal, of consent to self -insure, or o certificateof Workers' Compensation Inwit u c,Nt ZONING ENG. SITE NO. there.((Sec. 1 Policy N r5iRd jr_p4y gl�any ❑ Cer_l iiwd a,Pyrilnderchy furbished, FIRE SPRINK ENERGY T 2 ❑ Certified o y is III theory mspection divisi..T Applicant_ v ❑ N ❑ V ❑ N❑ MISC.- REFER TO ORD. C1-1RI I FI CATS O I' I KILNPTIO PROM WOR K ISRS' 0:5- PERMIT ISSUANCE '� . FLOODZONE A.L.U.C. PLG. CONTE. LIC. NO. PLG. OOv TOTAL O COJIPIiNSATION INSURANCE (This section need not be completed if the pennil is for one Y ❑ N❑ Y ❑ N❑ QTV. MECHANICAL PERMIT FEE FEE SUMMARY hundred dollars ($100) nr les.) I certify that in the performance of the work for which this per- TIE is issued, I shall not employ any person m any manner so as to BUILDING",70791 become subject to the Workers' Compensation Laws of California. Date Applicant NOl'ICE TO APPLICANT: IL after making this Certificate of Ex ALTER OR ADD TO MECH. 5.00 APPLIANCE 5.00 PLAN CHECK emptiun, you should become subject to (lie worker~• Co,npcnsation provisions of the Labor Code, you most forthwith comply with such provisions or this permit shall be deemed revoked. AIR HANDLING UNIT (TO 10=C.F.M.) 4.00 FEE AIR HANDLING UNIT(OVER 10=C.F.M.) 6.00 J SEISMIC FEE / PO CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance .f the work f... which this pennil is issued (Sea 3097. Civ.C.). Lender's Name EXHAUST HOOD (WITH DUCT) 5.00 MICROFILM HEATING UNIT (TO 100,000 B.T.U.) 8.00 HEATING UNIT IO VER 100,000B.T.U.0.50 ELECTRIC .3 oZ� Lender's Address I certify that I have read this application and state that me above information is correct. I agree to comply with all city and county ordinances and state laws relating to building construction, and hereby authorize representatives of this city to enter upon the abuvementioned property for inspection purposes. VENTILATION FAN (SINGLE) 4.00 ly , PLUMBING 6 g01LER-axvm l3 H.P. Dr 100,000 B.T.U.) 6-00 BOILER -COMP (Over 100.000 BTU) SEE FEE SCH. MECHANICAL �'� ..� MISC. - REFER TO ORD. (We) agree to save, indemnify and keep harniless the City o0 'upertiao against liabilities, judgments costs and expenses which may in any coy accrueinst sai City in consequence of Ihu CONST. TAX ' PERMIT ISSUANCE �-pp -. MECH. CONT. LIC. NO. MECH. TOTAL S� TOTAL ranting O( t It Signator o pplicant/Cool actor Date OFFICE COPY POST THIS CARD NEAR FRONT OF BUILDING CITY OF CUPERTINO - INSPECTION DIVISION JOB INSPECTION RECORD qq �� JOB ADDRESS 4L2Ktl 01}1<C46 -C C--/ UNIT# _LOT# ,( OWNER CONTRnCTOR (�,i/� �a Com(" PERMIT NUMBER 15074 PERMIT EXPIRATION PERMIT EXPIRES IF WORK IS NOT STARTED WITHIN 180 DAYS OF PERMIT ISSU . ANCE OR 180 DAYS FROM LASTCALLED INSPECTION. INSPECTION DAT INSPECTOR INSPECTION RECORD FOUNDATION NOTE: ALL GRADING AND DRAINAGE SHALL BE INSTALLED TO COMPLY WITH THE APPROVED PLANS AND CITY OF CUPERTINO STANDARDS. LIFER PREGUNITE 7- PERMIT VAuoATION ' ISSUANCti GARAGE SLABS POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED UNDERGROUND/SLAB PLUMBING ELECTRICAL MECHANICAL aLuc ELECr o Io PLDATE G. MECH R DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED BUILDING PERMIT INFORMATION WOOD FLOOR UATION PLUMBING ^� � V - /e.� MECHANICAL ELECTRICAL PERNIH TO �q,J. , , ; !�.,;'-? L• FRAMING INSULATION STORIES TYPE CONSIH OCC GROUP RES UNITS PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED - ROOF NOTE: NO FINAL INSP. SHALL BE MADE BEFORE THE CONSTRUCTION TAX IS PAID so FT FLoon aecA roT nl. ncvcar,E DIAPHRAGM BUILDING USE HCS IND UUN Pb 0.1,E SE EL ROOF SHEATHING APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ASSESSORS PARCEL NO ROUGH SAN.# PLUMBING ELECT, ENERGY IHAcr NO PARCEL No TUBS &SHOWER PAN PLUMBING ENERGY MECHANICAL MECR ENERGY ACC DATE ACC FILE NO ELECTRICAL BUILDING ENERGY FRAMING ELECT. FINAL TEST - ZONING ENG SITE NO. INSULATION PLUMBING 7-9,9- �(� -a'0- GAS TEST GAS GAS .).p F IRE SPRINK 1:1 rvE) ENERGY ja v ❑ NE] ' MECHANICAL COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING OD a000 zomC `' ❑ R n L u C. r L N EXTERIOR SHEAR ELECTRICAL RELEASE INTERIOR SHEAR FIRE DEPT. SHEETROCK GRADE FEE SUMMARY EXTERIOR LATH BUILDING 00 - BUILDING INTERIOR LATH TEMPORARY APPROVALS SCRATCH COAT,, ELECTRIC PLAN CHECK FEE GAS SEISMIC FEE i NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY OCCUPANCY OF BUILDING IS NOT PERMITTED UNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILM ARRANGE FOR INSPECTION BY PHONING 252-4505, HONE WORKING DAY BEFORE REQUIRED INSPECTION. O� PLEASE GIVE JOB ADDRESS WHEN PHONING. Z -SEE PERMIT FOR EXPIRATION DATE - ELECTRIC - PLUMBING I� MECHANICAL ,. r � CONST. TAX IMPORTANT! PLEASE READ REVERSE SIDE BEFORE CALLING FOR FINAL INSPECTION. TOTAL OFFICE COPY